A very wise decision, minister

In the run up to the NHS long-term plan, the realists in primary care had been steeling themselves to get pretty much sweet FA in terms of major investment in the next couple of years.

Expectation management was the name of the game, with most of the cash due in 2019 and 2020 thought likely to be soaked up by the acute sector sponge, which has been dried to a bone in recent times. Politicians will want to see progress on hospital targets ahead of a general election, surely, while mental health and cancer are at the front of the queue for improvement.

That is a familiar aspiration for many HSJ readers, as comments under the story made clear.

One was quick to note the potential knock-on consequences for the acute sector, adopting the part of Sir Humphrey: “Of course minister, a very wise decision if I may say so. Now, which hospitals shall we close to pay for it?”

Mr Hancock said the overall growth for the NHS should mean there is enough headroom to keep meeting hospital demand while its share of the whole pie shrinks (mental health has also been promised a growing slice). That’s open to debate, but it seems unlikely unless expectations of performance and quality improvement on acutes are strictly limited.

Practically, spending fast enough in primary and community care in a way that gets value, while keeping pace with uncontrolled acute costs, has proved difficult in some years. Getting that traction in time for 2019-20 will require pretty rapid movement now, too.